Viagra didn’t just pump up penises, it also helped bring a new legitimacy to those who studied sexual problems. As the film of Kinsey’s life showed, it wasn’t so long ago that sex researchers were frozen out of the mainstream of science and denied funding by government health authorities. In the late 1980s, leading voices were lamenting the fact that the study of sex was still sorely missing the ‘scientifically respectable apparatus’ of having its own academic departments and professors of sexuality. There were calls to create a rigorous new ‘sexual science’, with sound methods of doing both qualitative and quantitative research using reliable measurement tools.26 With the arrival of Viagra in the 1990s the fortunes of this field turned very rapidly around, as that ‘scientifically respectable apparatus’ began to be constructed. The drug industry soon extended the warm hand of friendship and funding, bringing sex researchers in from the cold and dark and helping them to build a whole new science of what’s becoming known as ‘sexual medicine’.27 For doctors and psychologists working in the area, the new wonder drug was something that would not only help their patients; it might also lift up an entire field of health research.
Even before the drug was officially launched for men, plans were underway to test it in women. The problem was that, unlike men—where success could be measured by the hardness of a man’s penis—it wasn’t exactly clear how to measure sexual pleasure in a woman. Should it be the size of her swelling clitoris, the number of her orgasms or her feelings of sexual arousal? At that point, a decision was made to gather together a small group of researchers who specialised in women’s sexuality, to start getting some answers. It would prove to be an historic gathering.
The quality of the light is one of the things that strike you first about Cape Cod in Massachusetts, in the northeast corner of the United States. It’s as if you can see things more clearly from there. The wildness of the beaches, the sensuality of the sunken meadows and the clean waters of the pristine ponds are a world away from the hustle and bustle of busy Boston and metropolitan America, a couple of hours up the highway. The Cape’s beauty has long attracted artists, travellers and holidaymakers, and in the spring of 1997 it brought together a very important group of doctors, sex researchers and drug company officials. They’d been assembled with the aid of a charismatic psychologist called Ray Rosen.
A tall, handsome man, Dr Rosen is highly regarded for his intelligence and clarity of vision. Friendly and well-connected, Rosen was at the time based at the Robert Wood Johnson Medical School in New Jersey, not far from New York, Pfizer’s home town. In the 1990s, while still testing Viagra, the company had been looking to make wider connections in the academic community, and Rosen would have appeared as a natural fit— particularly with his expertise in designing measurement tools, including questionnaires. Rosen would also have seen benefits in making links with a big pharmaceutical company. Apart from the funding for individual research projects and consultancies, the industry’s money could help raise the profile of the whole area of sex research, ultimately helping men and women with better care. It also presented a chance to get in on the ground floor and work with this revolutionary new approach to treating sexual dysfunction. Drugs were already around that could be injected into the penis to help men’s erections, but Pfizer’s new blue pill worked via a different, far more convenient, mechanism. Soon the New Jersey academic entered into a working relationship with the world’s biggest drug company.
As a psychologist, Ray Rosen was aware of the potential of counselling, and like many of his medical colleagues he shared what is known as a ‘bio-psycho-social’ approach to understanding and treating sexual problems that is both comprehensive and holistic. He was also enthusiastic about the possible role of prescription drugs for both sexes. Given what researchers knew from Masters and Johnson’s observations about the similarities in male and female sexual response, and the important role of genital blood flow in both sexes, it was theoretically possible that Viagra’s benefits for men could apply equally to women. For Rosen and many of his colleagues, new opportunities for both research and treatment were opening up before their eyes, and they would grasp them with enthusiasm and energy.
Before long, it wasn’t just Pfizer in the race: numerous drug companies were looking to develop their own experimental medicines, including the Californian outfit Vivus, which had high hopes its genital cream could sexually arouse millions of women. The industry was looking to make links with ‘thought leaders’ to help guide its drug development and raise awareness of FSD. Like health professionals across all areas of medicine, Ray Rosen embraced the chance to collaborate with industry— as would many others. The sort of the collaboration he had in mind was spelled out very clearly in an email he sent to one of his colleagues around this time, his old friend Leonore Tiefer.
Warm, gregarious and highly eloquent, Tiefer was already something of an identity in this small field, and both she and Rosen had already served terms as office holders of the International Academy of Sex Research. For more than a decade, Tiefer had been working in the urology departments of New York hospitals, interviewing men who were being treated for sexual problems, conducting research and writing. She had soon become concerned that men’s problems were being treated by the specialist urologists in a very mechanical way, and that sexual difficulties were being reduced to the quality of erections, divorced from the context of men’s lives and relationships. In 1986, long before Viagra came along, she had published an article titled ‘In Pursuit of the Perfect Penis’, which sounded early warnings about what she saw as the medical takeover of male sexuality.28
With the arrival of Viagra, and Pfizer’s entry into the field in the 1990s, Tiefer was soon foreseeing a powerful alliance emerging—a medicalisation of sexual difficulties driven by the medical profession and fuelled by pharmaceutical money. Her response to the rivers of funding starting to flow from drug companies was very different from Ray Rosen’s. Her worry was that the small pools of sex researchers were in danger of being inundated by the muddy waters of drug company influence.29 She was concerned that this might contract the focus of research on to the narrow, more physiological aspects of sexuality—like blood flow and hormones—for women as well as men. She’d heard that her old mate Ray Rosen was organising an important gathering on women’s sexuality in Cape Cod, so she’d emailed him asking about the possibility of attending.
Rosen’s reply to the request was blunt. The two were old friends so he felt he could be candid with her. He revealed that the main point of the meeting was to work out how to assess female sexual function in clinical trials involving drugs. In other words, the meeting would focus on how to measure the impacts of experimental drugs like Viagra on women. Perhaps even more importantly, his email revealed that the drug companies would be picking up the tab for the entire Cape Cod affair:
The meeting is completely supported by pharmaceutical companies, and approximately half of the audience will be pharmaceutical representatives. The goal is to foster active and positive collaboration between the two groups. Only investigators who have experience with, or special interest in working collaboratively with the drug industry have been invited, and that’s the obvious reason I had not included you. Your views of the issue are very well known to all.30
Rosen’s email went on to offer Tiefer the chance to attend only if she was ‘willing to genuinely participate’ in the meeting, an offer she ultimately declined after much deliberation, deciding she did not want to be part of this emerging collaboration with industry. Others had no such reservations, and a core of sex experts and drug company officials soon flew into Cape Cod from across the United States and around the world.
That Cape Cod conference marks the dawning of the new era of ‘active and positive’ collaboration between the global pharmaceutical industry and a small group of highly influential sex researchers focused on women’s sexual problems. Discussions at that meeting would help inform a whole new scientific agenda, ultimately